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Cureus Aug 2022Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the... (Review)
Review
Children are particularly terrified of having dental treatment. They are physically resistant, frail, and unwilling to cooperate. This severe distress during the pre-operative phase could cause the dentist to have issues with behavior control. Additionally, it may make pediatric dental treatments less effective. In order to reduce anxiety and control behavior in children receiving dental care, sedation is a pharmacological management technique that supports the provision of effective and high-quality dental services. The aim is to compare and evaluate the efficacy of sedative agents like dexmedetomidine and midazolam in pediatric dental practice. A thorough review of the literature was conducted using electronic databases like "MEDLINE, PubMed, and CENTRAL (Cochrane Central Register of Controlled Trials), as well as the World Health Organization International Clinical Trials Registry Platform, www.clinicaltrials.gov, conference proceedings abstracts, a bibliography of pertinent references, and manual searches of journals, conferences, and books". There were no restrictions on the language or the date of publication when searching the electronic databases. Randomized controlled trials were included which compared dexmedetomidine and midazolam in children up to 16 years of age subjected to dental treatment. Information on procedures, participants, interventions, outcome measures, and results were independently extracted by three review writers (TS, SL, and RO). Trial authors were contacted for papers that were confusing or lacking information. The risk of bias was evaluated for each study. We adhered to the Cochrane statistical recommendations. Three trials totaling 229 participants were included. All three studies were rated as having a low risk of bias, with none of them having a high or unclear risk. Meta-analysis was done for the available data for the primary outcomes like sedation level and recovery time. We searched for randomized controlled trials up to Jan 31, 2020. Participants are randomly assigned to an intervention or control group in randomized controlled trial research. While patients in the control group often get a placebo therapy or procedure, those in the interventional group receive the treatment being studied. We found three studies eligible to include in the review. One study evaluated 73 individuals who received general anesthesia for dental treatment. There were 72 and 84 individuals in the second and third investigations, respectively. All the participants of the three studies were divided randomly into two groups and were subjected to dexmedetomidine and midazolam as sedative agents. We gave the evidence an "extremely low certainty" rating. Because there are just three short trials with unusual parameters for comparison, the results are questionable. Overall, the results do not allow us to draw any firm conclusions. Three randomized controlled trials included in this systematic review reported data with varying conclusions; hence we recommend more randomized controlled trials to be conducted on this subject matter.
PubMed: 36176880
DOI: 10.7759/cureus.28452 -
Brain Communications 2022The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery... (Review)
Review
The nature and extent of persistent neuropsychiatric symptoms after COVID-19 are not established. To help inform mental health service planning in the pandemic recovery phase, we systematically determined the prevalence of neuropsychiatric symptoms in survivors of COVID-19. For this pre-registered systematic review and meta-analysis (PROSPERO ID CRD42021239750), we searched MEDLINE, EMBASE, CINAHL and PsycINFO to 20 February 2021, plus our own curated database. We included peer-reviewed studies reporting neuropsychiatric symptoms at post-acute or later time-points after COVID-19 infection and in control groups where available. For each study, a minimum of two authors extracted summary data. For each symptom, we calculated a pooled prevalence using generalized linear mixed models. Heterogeneity was measured with . Subgroup analyses were conducted for COVID-19 hospitalization, severity and duration of follow-up. From 2844 unique titles, we included 51 studies (= 18 917 patients). The mean duration of follow-up after COVID-19 was 77 days (range 14-182 days). Study quality was most commonly moderate. The most prevalent neuropsychiatric symptom was sleep disturbance [pooled prevalence = 27.4% (95% confidence interval 21.4-34.4%)], followed by fatigue [24.4% (17.5-32.9%)], objective cognitive impairment [20.2% (10.3-35.7%)], anxiety [19.1% (13.3-26.8%)] and post-traumatic stress [15.7% (9.9-24.1%)]. Only two studies reported symptoms in control groups, both reporting higher frequencies in COVID-19 survivors versus controls. Between-study heterogeneity was high ( = 79.6-98.6%). There was little or no evidence of differential symptom prevalence based on hospitalization status, severity or follow-up duration. Neuropsychiatric symptoms are common and persistent after recovery from COVID-19. The literature on longer-term consequences is still maturing but indicates a particularly high prevalence of insomnia, fatigue, cognitive impairment and anxiety disorders in the first 6 months after infection.
PubMed: 35169700
DOI: 10.1093/braincomms/fcab297 -
The Journal of Craniofacial Surgery Sep 2022Syndrome of the trephined (SoT) is a severe complication following decompressive craniectomy resulting in neurological decline which can progress to aphasia, catatonia,... (Review)
Review
Syndrome of the trephined (SoT) is a severe complication following decompressive craniectomy resulting in neurological decline which can progress to aphasia, catatonia, and even death. While cranioplasty can reverse neurological symptoms of SoT, awareness of SoT is poor outside of the neurosurgery community. The authors performed a systematic review of the literature on SoT with a focus on reconstructive implications. Search terms "syndrome of the trephined" and "sunken flap syndrome" were applied to PubMed to identify primary studies through October 2021. Full-text review yielded 11 articles discussing SoT and reconstructive techniques or implications with 56 patients undergoing cranial reconstruction. Average age of the patients was 41.8±9.5 years. Sixty-three percent of the patients were male. The most common indication for craniectomy was traumatic brain injury (43%), followed by tumor resection (23%), intracerebral hemorrhage (11%), and aneurysmal subarachnoid hemorrhage (2%). Patients most commonly suffered from motor deficits (52%), decreased wakefulness (30%), depression or anxiety (21%), speech deficits (16%), headache (16%), and cognitive difficulties (2%). Time until presentation of symptoms following decompression was 4.4±8.9 months. Patients typically underwent cranioplasty with polyetheretherketone (48%), titanium mesh (21%), split thickness calvarial bone (16%), full thickness calvarial bone (14%), or split thickness rib graft (4%). Eight percent of patients required free tissue transfer for soft tissue coverage. Traumatic Brain Injury (TBI) was a risk factor for development of SoT when adjusting for age and sex (odds ratio: 8.2, 95% confidence interval: 1.2-8.9). No difference significant difference was observed between length until initial improvement of neurological symptoms following autologous versus allograft reconstruction (P=0.47). SoT can be a neurologically devastating complication of decompressive craniectomy which can resolve following urgent cranioplasty. Familiarity with this syndrome and its reconstructive implications is critical for the plastic surgery provider, who may be called upon to assist with these urgent cases.
Topics: Adult; Brain Injuries, Traumatic; Decompressive Craniectomy; Dental Implants; Female; Humans; Male; Middle Aged; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies; Skull; Syndrome
PubMed: 36054899
DOI: 10.1097/SCS.0000000000008724 -
Journal of Oral and Maxillofacial... Apr 2022The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional... (Review)
Review
PURPOSE
The aim of this study is to assess whether the use of computerized devices to deliver local anesthesia results in less pain and anxiety compared to traditional anesthesia in adult dental procedures.
METHODS
This review was registered at PROSPERO (CRD 42021265046), based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and was structured according to the PICO strategy. The studies were selected based on eligibility criteria, and data were collected by 1 author and reviewed by another.
RESULTS
Nine of the 10 studies included were randomized controlled trials. Differences related to pain and anxiety were observed, which favored computerized techniques; however, caution should be exercised when interpreting these results due to differences in assessment methods. The studies used different local anesthetics, including 2% lidocaine, 4% articaine, or 3% mepivacaine with epinephrine diluted 1:80,000 to 1:200,000. A total of 560 patients were evaluated.
CONCLUSIONS
Computerized anesthesia devices yielded better results than conventionally delivered anesthesia after qualitative evaluation. Nevertheless, conventional anesthesia is widely used, safe, and effective. Due to the heterogeneity among the included studies, it is strongly recommended that new randomized clinical trials using well-defined methodologies be performed to improve the quality of evidence regarding this topic.
Topics: Adult; Anesthesia, Dental; Anesthesia, Local; Anesthetics, Local; Anxiety; Carticaine; Humans; Lidocaine; Pain
PubMed: 34942152
DOI: 10.1016/j.joms.2021.11.018 -
Journal of the Indian Society of... 2021Pain, fear, and anxiety have long been associated with pediatric dentistry. A child's cooperation with a dental.procedure.usually requires various behavioral management... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Pain, fear, and anxiety have long been associated with pediatric dentistry. A child's cooperation with a dental.procedure.usually requires various behavioral management strategies conveyed by the entire dental team. The use of sedatives in dental clinics for providing analgesia and anxiolysis allows the patient to respond appropriately to verbal commands and light tactile stimulation., thus making dental treatment more patient friendly and effective.
AIM
The aim of this study was to compare the safety and efficacy of dexmedetomidine versus midazolam for the management of pediatric patients in the dental clinic.
MATERIALS AND METHODS
This systematic review was prepared according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Six articles were selected for this systematic review. Of them, only in four articles, homogeneous data were available which were subjected to meta-analysis.
RESULTS
When compared with midazolam, premedication with dexmedetomidine resulted in much lower incidence of emergence delirium (odds ratio = 0.07, 95% confidence interval: 0.01-0.54, P = 0.01). No significant difference was observed with respect to satisfactory behavior of the child, successful parental separation, and satisfactory mask acceptance following sedation.
CONCLUSION
Both dexmedetomidine and midazolam are equally effective for the management of pediatric patients in the dental clinic. In addition, dexmedetomidine premedication is associated with lower incidence of emergence delirium and has a better margin of safety.
Topics: Child; Dexmedetomidine; Humans; Hypnotics and Sedatives; Midazolam; Premedication
PubMed: 34810337
DOI: 10.4103/jisppd.jisppd_517_20 -
Community Dentistry and Oral... Apr 2024Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can... (Review)
Review
BACKGROUND
Little is known about patients' or carers' reported experiences of dental care provided using dental behaviour support (DBS) techniques. Qualitative literature can provide unique insight into these experiences.
AIM
To explore and synthesize qualitative literature related to patient experience of dental behaviour support.
METHODS
A PROSPERO-registered systematic review of qualitative articles was undertaken. Studies were identified through MEDLINE, Embase and PsycINFO. Abstracts were screened by two reviewers and data were extracted to summarize the qualitative findings included within them. A thematic summary approach was used to synthesize the qualitative data identified.
RESULTS
Twenty-three studies were included. Studies primarily explored experiences of dental care of children by speaking to their parents (n = 16), particularly regarding paediatric dental general anaesthesia (DGA) (n = 8). Studies of adults' experiences of DBS (n = 7) covered a range of techniques. Nine studies explored broader dental care experiences and did not study specific DBS approaches. A thematic synthesis identified five themes applicable across the studies identified: Trust and the therapeutic alliance supporting effective care delivery; considered information sharing often alleviated anticipatory anxiety; control and autonomy-reduced anxieties; variations in the perceived treatment successes and failures of DBS techniques; and DBS techniques produced longer positive and negative impacts on patients beyond direct care provision.
CONCLUSION
Qualitative research has been under-utilized in research on DBS techniques. Care experiences of most DBS techniques outside of paediatric DGA are poorly understood. Building trust with patients and enabling autonomy appear to support positive patient-reported experiences of care.
PubMed: 38680013
DOI: 10.1111/cdoe.12969 -
European Journal of Oral Sciences Aug 2023This systematic review aimed to investigate whether root canal treatment caused greater stress than other dental treatments for patients and dentists. All peer-reviewed... (Meta-Analysis)
Meta-Analysis Review
This systematic review aimed to investigate whether root canal treatment caused greater stress than other dental treatments for patients and dentists. All peer-reviewed literature published in English between January 1990 and January 2023 was included. This included randomized/non-randomized control trials, cohort studies, case-control studies, and cross-sectional studies. An electronic search used PubMed, Scopus, Medline, Cochrane Collaboration, and Embase. Hand searching supplemented the screening pool. Studies examining physiological or psychological stress measures within patients or providers of dental treatment (dentists, dental specialists, and dental students) were eligible. The study must have reported on the stress outcome for root canal treatment and at least one other dental procedure. After screening 3639 eligible records, there were 23 studies included, varying from very-low to low certainty of evidence. This review found that root canal treatment was more psychologically stressful for patients than routine restorative or cleaning procedures. However, the stress of root canal treatment relative to other dental procedures, especially extractions, was inconclusive for both dental patients and providers. Since patients regard root canal treatment as more stress-evoking than other routine dental procedures, providers should endeavour to minimise their own bias toward root canal treatment when providing adequate information for an informed treatment choice.
Topics: Humans; Cross-Sectional Studies; Dental Pulp Cavity; Root Canal Therapy; Dentists; Case-Control Studies
PubMed: 37357152
DOI: 10.1111/eos.12941 -
Journal of Education and Health... 2021The outbreak of the COVID-19 epidemic started in late 2019 in Wuhan, China, causing many psychological and occupational effects for the medical staff, including dentists... (Review)
Review
The outbreak of the COVID-19 epidemic started in late 2019 in Wuhan, China, causing many psychological and occupational effects for the medical staff, including dentists and all those who work to promote oral health. The present systematic review study investigates the psychological causes and effects of the COVID-19 epidemic outbreak on dentists. Systematic search was performed on valid databases such as Science Direct, Web of Science (WoS), Embase, Cochrane, and Scopus. The English articles published from December 2019 to November 2020 were selected according to the inclusion and exclusion criteria. The quality of the articles was assessed using an existing checklist. Then, their full texts were reviewed to extract the necessary data. Finally, the data were summarized in a table. This systematic review study showed the emergence of psychological symptoms such as fear, anxiety, and stress are the three most common disorders in dentists and all those who work to promote oral health as the medical staff. This pandemic has had occupational and economic consequences for dentists. In general, the research results indicated that the outbreak of COVID-19 had affected the dental profession in two areas: (1) Psychological consequences: Reviewing the articles showed that the essential psychological effects in the dental profession are the fear of infection by patients, anxiety, and stress, respectively. (2) Occupational effects: The second significant consequence of the COVID-19 outbreak was that due to fear and anxiety of getting infected with the virus in the dental environment, containing particles and aerosols from patients' saliva and blood, dentists had to limit doing their jobs in the emergency room and sometimes even closing their offices. This issue may cause economic problems for their professions. There is also a need to allocate additional costs for the provision of sanitary equipment.
PubMed: 34667811
DOI: 10.4103/jehp.jehp_1637_20 -
Medical Science Monitor : International... Jul 2022BACKGROUND Dental anxiety can impact oral health and dental treatment in patients of all age groups, which seems to be an obstacle to quality dental care. This...
BACKGROUND Dental anxiety can impact oral health and dental treatment in patients of all age groups, which seems to be an obstacle to quality dental care. This systematic review of the literature aimed to evaluate the findings from cross-sectional studies conducted in the Kingdom of Saudi Arabia (KSA) on levels of dental anxiety (DA) between genders and among various demographic groups. MATERIAL AND METHODS An electronic search of PubMed, Embase, and Web of Science databases was carried out in January 2022. Studies that measured dental anxiety in Saudis in all regions of the KSA by direct evaluation and interviews were included. Studies that were not in the English language or used proxy measures were excluded. Quality assessment was carried out using Joanna Briggs Institute's critical appraisal tool for cross-sectional studies. RESULTS A total of 19 cross-sectional studies from the KSA were identified that used validated anxiety scales, including the Corah Dental Anxiety Scale (DAS), the Corah Dental Anxiety Scale, Revised (DAS-R), and the Modified Dental Anxiety Scale (MDAS). All studies were rated as having a high risk of bias. A mild level of DA was the most common among participants in the KSA. CONCLUSIONS The findings from this systematic review showed that in the KSA, although a mild level of dental anxiety was most common in the study participants, women, young adults, and university students showed a higher prevalence of dental anxiety. However, the lack of sufficient literature to support the current findings make an overall conclusion about DA extremely difficult.
Topics: Cross-Sectional Studies; Dental Anxiety; Female; Humans; Male; Oral Health; Prevalence; Saudi Arabia; Young Adult
PubMed: 35908171
DOI: 10.12659/MSM.937470 -
International Journal of Environmental... Sep 2022This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under... (Meta-Analysis)
Meta-Analysis Review
This report investigated the effectiveness of non-pharmacological interventions for reducing dental fear and anxiety in patients undergoing third molar extraction under local anesthesia. In November 2020, multiple electronic databases (Cochrane, EMBASE, MEDLINE, PsycInfo, PsycArticles, PubMed, and Web of Science) were searched for articles published in English. Inclusion criteria were randomized-controlled trials reporting the effectiveness of any non-pharmacological interventions in reducing fear or anxiety levels in patients with third molar extraction. A total of 3015 studies by electronic search and 2 studies by hand search were identified. After screening, 21 studies were eligible for systematic review. Seven studies were included in the meta-analysis. Study selection, data extraction, and quality assessment of the included studies were performed by two independent investigators. The anxiety levels after intervention in each study were pooled and meta-analyzed by the random-effect model. A significant reduction in anxiety level was observed in non-pharmacological intervention groups (SMD = -0.32; 95% CI -0.57 to -0.07; = 0.01). Subgroup analyses showed that a significant anxiety reduction by non-pharmacological interventions could be demonstrated by pooled data from studies using psychometric assessments, but not from studies using physiological assessments. Non-pharmacological interventions appear to reduce fear and anxiety levels in patients undergoing third molar extraction under local anesthesia.
Topics: Anesthesia, Local; Anxiety; Anxiety Disorders; Humans; Molar, Third; Randomized Controlled Trials as Topic
PubMed: 36141435
DOI: 10.3390/ijerph191811162